Upstate News

SUNY Upstate Medical University psychiatrist Steven L. Batki, M.D., has been awarded a nearly $2.2 million four-year federally funded grant to test the effectiveness of a medication to treat alcohol abuse in people with serious mental illness. The medication, naltrexone, may help patients who have schizophrenia to reduce their alcohol use and improve their functioning in the community. The four year study, “Naltrexone Treatment of Alcohol Abuse in Schizophrenia,” is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH).

Alcohol abuse is very common among patients with severe mental illness. It is estimated that there may be as many as 750,000 people in the United States who have both schizophrenia and alcohol problems. Alcohol abuse requires treatment because it is known to worsen the course of schizophrenia and to contribute to rehospitalization.

The NIH funding is the result of a pilot study Batki began in August 2000 that assessed the feasibility of a clinical trial of naltrexone treatment of alcoholism in seriously mentally ill patients. That pilot study was seeded by a grant from SUNY Upstate222s Intramural Research Grant Program.

According to Batki, naltrexone has been shown to be effective in treating alcoholism in other populations. However, prior to his pilot study, few published reports had examined naltrexone treatment of alcohol abuse in patients with serious mental illness.

“If, as hoped, patients with schizophrenia respond well to naltrexone and reduce their alcohol use, they may obtain the added benefits of reduced severity of psychiatric symptoms and less use of inpatient and emergency psychiatric services,” Batki said.

A key aspect of the proposed research is the one-stop shopping concept of integration of alcoholism treatment into the clinical settings where outpatient mental health services are provided for people with schizophrenia. That way, patients do not have to go to two different places for alcoholism and mental health care. Traditionally, such services have been provided in separate locations, making it hard for patients to receive both mental health and substance abuse treatment simultaneously.

Batki will study a total of 150 patients in this double-blind, randomized, placebo controlled trial. Each patient will be in the study for six months, getting a three-month course of the study medication plus several monthly follow-up visits after discontinuation of medication. The participants will be directly observed taking study medication three times per week. Weekly counseling sessions will also be provided to increase motivation to stop drinking. Incentives consisting of coupons for goods or services will be provided to study participants to ensure their attendance.

The study outcomes will consist of measures of the participants’ alcohol use and psychiatric symptoms and their use of medical and psychiatric services.

Naltrexone is approved by the FDA for the treatment of alcoholism as well as opiate drug addiction. It works by reducing the effect of drugs and alcohol on the brain’s opiate receptors and therefore reducing the pleasurable effects of alcohol use.

According to the NIAAA, naltrexone and other potential agents now under investigation target hallmark features of alcoholism: abnormal alcohol-seeking behavior, impaired control over alcohol intake, and craving when alcohol is removed. Naltrexone appears to reduce craving in abstinent patients and to block the reinforcing effects of alcohol in patients who drink. The latter effect lessens the likelihood that patients who drink a small amount of alcohol will return to heavy drinking.

Batki has been conducting NIH-funded research in the addictions for more than 15 years, first at the University of California, San Francisco, and for the past three years at SUNY Upstate. He has authored numerous publications on addiction, mental health, and public health topics.

Batki and his research group, which includes coinvestigators Drs. Kate Carey and Stephen Maisto of Syracuse University, and research manager Dr. Jacqueline Dimmock in the Department of Psychiatry at SUNY Upstate, will begin their research study later this summer and will continue this work until 2007.

Batki, the study’s principal investigator, is professor of psychiatry and director of psychiatric research at SUNY Upstate. He will conduct the study at SUNY Upstate, Hutchings Psychiatric Center and the Syracuse Veterans Administration Medical Center as well as at other outpatient sites where patients with schizophrenia receive mental health treatment. He is also conducting research on the co-occurrence of other addictions with medical and psychiatric disorders, including a project treating nicotine dependence in serious mental illness. He is also collaborating with the Department of Medicine’s Dr. Robert A. Levine at SUNY Upstate on a study regarding the integrated treatment for Hepatitis C in patients with heroin addiction.